Criterion 5.3.1

Safe and quality use of medicines

Indicators

► A. Our clinical team can demonstrate how our patients are informed about the purpose, importance, benefits and risks of their medicines and how patients are made aware of their own responsibility to comply with the recommended treatment plan.

► B. Our clinical team can demonstrate how we access current information on medicines and review our prescribing patterns in accordance with best available evidence.

► C. Our clinical team can demonstrate how we ensure patients and other health providers to whom we refer receive an accurate and current medicines list.

► D. Our clinical team can demonstrate how we ensure that medicines (including samples and medical consumables) are acquired, stored, administered, supplied and disposed of in accordance with manufacturers’ directions and jurisdictional requirements.

Explanation

Key points

Patients need to understand the purpose and importance of medicines, to assist them to comply with a recommended treatment plan

General practitioners need access to current information on medicines to enable best practice prescribing

Patients need accurate and current medication lists

Referral documentation should include accurate and current medication lists

Practices need to ensure that medicines (including samples and medical consumables) are not used beyond their expiry dates

Practices must comply with jurisdictional requirements on Schedule 4 and Schedule 8 medicines.

Medication purpose, options, benefits, risks

Patients need to understand the rationale for taking medications, and the benefits and risks associated with particular medicines. This will assist patients to make informed decisions regarding their treatment and may also assist in improving compliance with the recommended treatment plan.

Information resources for consumers

Consumer Medicines Information (CMI) can assist patients in understanding their medicines. Where patients cannot understand written language or where information is not available in the patient’s language, the use of pictorial media or translators may be appropriate. It is particularly important that patients understand the difference between generic drugs and trade named drugs so dosage problems are avoided.

The APAC Guiding principles for medicines management in the community Principle 1 includes a list of information resources:

Pharmacists can facilitate the optimal use of medicines. A good partnership between the GP, patient and pharmacist can enhance the benefits to the patient in managing their medicines.

Community pharmacists can assist in providing a comprehensive review of a patient’s medicines and feedback to the GP, either through an in-pharmacy Medicines Use Review or an in-depth Home Medicines Review.

Using and reviewing best practice treatment

Relevant therapeutic guidelines available at this website to support best practice prescribing include:

analgesic guidelines

antibiotic guidelines

cardiovascular guidelines

dermatology guidelines

respiratory guidelines.

Particular care needs to be taken with soundalike or lookalike medicines, particularly when using ‘drop down’ boxes in electronic prescribing programs.

Ensuring medicines lists are accurate and current

General practitioners need to regularly review the list of a patient’s current medications to ensure the list is up-to-date and does not lead to errors when prescribing or referring.14 Single use medications, including antibiotics, should be removed from patients’ records when they are no longer required.

Reviewing a medicines list with a patient15 also provides an opportunity for the GP to assess the patient’s compliance with a medication regime to identify the need for any further education/support. Many GPs routinely perform this task prior to prescribing or changing treatment. It is recommended that GPs clarify a patient’s current medicines list and known allergies at every patient contact.

Patients also need to be provided with a new medicines list when their medicines are changed. This is particularly important when multiple medicines are being taken.16 In assessing this indicator the ‘common sense rule’ needs to be applied: a medicines list may not need to be provided for antibiotics or contraceptive pills.

General practitioners need to be aware of the use of complementary medicines and the potential for side effects and drug interactions with conventional medicines. This should be noted on letters of referral including those for hospital admissions. In summary, it is useful to include all medicines (prescription and nonprescription medicines and complementary healthcare products, if known) on the medication list.

Following the manufacturer’s directions

To ensure the safe use of medicines, vaccines and other healthcare products, practices need to make sure they do not use perishable materials beyond their expiry dates. It is also important to ensure that medicines, vaccines and other healthcare products are stored appropriately, including being secured where appropriate.

It is useful to appoint a designated person to take primary responsibility for the proper storage and security of medicines, vaccines and other healthcare products.

Schedule 4 and Schedule 8 medicines

The acquisition, use, storage and disposal of Schedule 4 and Schedule 8 medicines are subject to jurisdictional legislative requirements.

For information on jurisdictional requirements refer to the drugs and poisons branch of the relevant jurisdiction:

Other useful resources

National Prescribing Service national medicines line (1300 633 424) is a telephone service providing consumers with information on prescription, over-the-counter and complementary (herbal/’natural’/vitamin/mineral) medicines. Patients can be referred from anywhere in Australia for the cost of a local phone call (calls from mobiles may cost more).

Criterion 5.3.1

Safe and quality use of medicines

In a nutshell

Many Aboriginal community controlled health services face particular challenges in relation to this criterion. Transporting and storing temperature-sensitive medicines is a challenge for some remote services. In addition, for financial, cultural or other reasons patients may be reluctant to fill their prescriptions or to take their medication as recommended. A range of government and other initiatives has been developed to try to address these factors.

Your health service needs to also ensure that it maintains a shame-free environment, where patients feel comfortable and safe discussing issues related to the prescription and use of medicines.

Key team members

Health service manager

Clinic staff

Designated clinic team member responsible for storage and security of drugs

▶ A. Our clinical team can demonstrate how our patients are informed about the purpose, importance, benefits and risks of their medicines and how patients are made aware of their own responsibility to comply with the recommended treatment plan.

It is vital that patients understand the reasons for taking medicines, how important it might be that they take them as prescribed and the benefits and risks involved. When patients understand the ‘why’ and ‘what if’ of their medicines, they are more likely to take them and to adhere to the recommended treatment plans.

Effective, open and culturally appropriate communication, sometimes about the patient’s life situation, is critically important in promoting treatment uptake. When prescribing medicine, your doctors need to provide clear advice to minimise risk and maximise medicine safety. Information about medicines can be communicated to patients via:

A good relationship between your health service and a pharmacist can also help patients feel more comfortable about taking the medication.

▶ B. Our clinical team can demonstrate how we access current information on medicines and review our prescribing patterns in accordance with best available evidence.

Immediate and quick access to resources that help doctors to keep up to date with current information on medicines, and to review their prescribing patterns in accordance with best available evidence, is important to achieving the safe and quality use of medicines. Your health service is advised to make these resources available to doctors when they see patients.

It is now considered standard practice to use the Therapeutic guidelines, which are available online (see Other information for Standard 5.3). Relevant therapeutic guidelines available to support best-practice prescribing include:

analgesic guidelines

antibiotic guidelines

cardiovascular guidelines

dermatology guidelines

respiratory guidelines.

A number of computer-based clinical decision-support tools are becoming more widely available. These provide an electronic platform that can host a range of products which can be selected to suit your health service’s needs. This includes the use of the Australian medicines handbook online. Such tools have an interactive and searchable format, enabling doctors to access independent, evidence-based drug information during the consultation.

▶ C. Our clinical team can demonstrate how we ensure patients and other health providers to whom we refer receive an accurate and current medicines list.

Medicine lists are lists of patients’ current medication and should be accurate and regularly updated. This means that medicines that are single-use need to be deleted from the list when they are no longer required.

It is recommended that your doctors:

regularly review medicine lists with patients; this gives them an opportunity to also determine whether patients are taking up the treatment, and whether further education or support is required. Many doctors do this routinely and prior to prescribing or changing treatment. It is highly recommended that doctors do this at every patient contact

provide patients with new medicine lists when medicines are changed

include prescription and non-prescription medicines, as well as complementary and traditional medicines

attach medicine lists to referral letters to other health providers and explain to the patient why they are doing this.

▶ D. Our clinical team can demonstrate how we ensure that medicines (including samples and medical consumables) are acquired, stored, administered, supplied and disposed of in accordance with manufacturers’ directions and jurisdictional requirements.

It is recommended that a designated person takes primary responsibility for the proper storage and security of medicines, vaccines and other health products. This person needs to have good reading and writing skills and be familiar with the legal requirements of Schedule 4 and Schedule 8 medicines regarding their acquisition, storage and disposal. A policy and procedure manual and register relating to the storage and security of medicines is recommended, to assist with jurisdiction requirements and manufacturers’ directions.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure it has a safe and quality use of medicines. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The health service understands that there are some important issues it needs to get right if it is to ensure it prescribes and manages medicines safely and appropriately for its patients. These issues include:

effective two-way communication with patients (including where patients speak English as a second or third language) to ensure full understanding of medicines and their use

patient understanding of medical terminology

patient understanding and acceptance of the Western medical model and use of medicines and other treatments, including the benefits and risks associated with not taking prescribed medicines

financial and other barriers to accessing medicines

the importance of a trusting and respectful relationship between GPs and their patients

the development of health literacy amongst the patient population, to encourage patients’ active participation in the healthcare process.

Consequently the service takes its responsibilities with regards to prescribing, dispensing and administering medicines very seriously. Its GPs and other health professionals are responsible for ensuring that appropriate patient communication and education processes are in place to ensure informed choice and consent occurs. This is seen as particularly important for patients who are used to taking traditional medicines.

GPs take time when talking about prescribing new medicines to a patient in order to explain carefully and in clear, plain language the reasons for prescribing this medicine, its benefits and any side effects, and the importance of taking it as prescribed. They also take time to check whether their patients fully understand what has just been said, and encourage them to talk about how they feel about getting the medicine and taking it in accordance with the prescription. This can mean that patients will tell GPs important and relevant things that they might not otherwise say.

Importantly, GPs listen to what their patients have to say and show understanding of any concerns or problems that they raise. They then work with patients to try to resolve any issues getting in the way of them taking the necessary medicines. Where necessary GPs will include an interpreter in these consultations, or an Aboriginal health worker from the same community as the patient. The receptionist often plays a role in this by encouraging patients to think about any questions they might have before they go in to see a GP.

All patients are encouraged to contact the service if they have any questions or concerns about their medications and an appointment will be made for a review of their medicines if required. At the next visit, GPs will ask patients how they are going with their new medicine, carefully listens to their response and work through any issues or concerns that patients raise.

GPs select formulations that are appropriate for their patients and tailor drug regimens to their needs (for example, appropriate dosing intervals and drug combinations). Dose administration aids are recommended, where appropriate. Because of the risk of frequent power cuts affecting refrigeration and storage facilities, where possible preparations appropriate for an environment with limited storage conditions are selected.

The doctors review current medicines, including complementary and traditional medicines, at each consultation and remove medicines that are not currently prescribed or were short term and are now completed – for example, antibiotics. Patients are given updated medicines lists when changes have been in made in their treatment. The doctors explain carefully to patients why these changes have been made.

Nurses and Aboriginal health workers provide instruction, education and demonstration on how to use inhalers. Aboriginal health workers are often involved with some consultations and medicine reviews, because they can assist communication and can also interact with pharmacists to ensure an appropriate two-way information exchange.

The health service has a good relationship with the local pharmacists and maintains regular communication with them, including the two-way provision of feedback if problems arise.

The waiting room contains a looping video and posters and brochures on the safe use of medicines – for example, not giving one person’s medicines to another person.

Staff members can demonstrate how they access medicines information in the clinical software program, Therapeutic guidelines and the CARPA manual and how they review their prescribing patterns in accordance with best available evidence.

Patient referral letters to external health providers contain a list of medications that is current on the day the referral was made.

Medicines are kept in a secure, locked area that is not accessible to patients. Before any medicines are stored, designated staff members check the expiry date and recommended storage options. Staff members rotate the older stock forward according to expiry date when storing new stock.

Staff check expiry dates of all medicines each month and document them in a log book. There is a system in place where different coloured stickers are used for different years of expiry – for example, medicines due to expire in 2013 have a yellow sicker, 2014 have a blue sticker, 2015 have a green sticker. This method means that staff members only need to check the medicines with the coloured sticker of the current year; this saves a considerable amount of time.

Schedule 8 medicines are kept in a locked safe and all of these drugs are checked every month and documented in the Schedule 8 drug book according to state or territory legislation.

Showing how you meet Criterion 5.3.1

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

Use videos, brochures and posters.

Keeps medicines review documentation in patient health files.

Maintain instructions on how to use inhalers.

Use a current clinical software program.

Use the Therapeutic guidelines – electronic and hardcopy format.

Keep a current medicines list and referral letters in patient health files.